参附注射液对急性ST段抬高型心肌梗死并发心源性休克患者炎性因子水平的影响

Effect of Shenfu injection on inflammatory factors in patients with acute ST-segment elevation myocardial infarction complicated with cardiogenic shock

目的 探讨参附注射液对急性ST段抬高型心肌梗死（STEMI）并发心源性休克（CS）患者炎性因子水平的影响.方法 选取2013年6月至2015年6月于首都医科大学附属北京安贞医院住院接受急诊经皮冠状动脉介入及主动脉内球囊反搏（IABP）治疗的STEMI并发CS患者60例.所有患者完全随机分为IABP组和IABP＋参附组,各30例.IABP＋参附组给予IABP＋参附注射液（100 ml/24 h微量泵泵入）治疗,IABP组只给予IABP治疗.比较2组患者入院即刻和入院后24、48、72 h的C反应蛋白（CRP）、白细胞介素6（IL-6）水平.比较2组IABP支持时间、住院时间、院内及随访主要不良心脑血管事件（MACE）发生率,分析院内MACE事件的独立危险因素.结果 2组患者入院后24、48、72 h的CRP水平均明显高于入院即刻[IABP组：（33±5）、（35±3）、（30±3） g/L比（23±5）g/L,IABP＋参附组：（31±4）、（31±5）、（28 ±5）g/L比（26±3）g/L],IABP＋参附组患者入院后48、72 h的CRP水平明显低于IABP组,差异均有统计学意义（均P＜0.05）.IABP＋参附组患者入院即刻IL-6水平明显高于IABP组[（112±19） ng/L比（104±10） ng/L],差异有统计学意义（P＜0.05）,但入院后24、48、72 h的IL-6水平与IABP组比较,差异均无统计学意义（均P＞0.05）.IABP＋参附组IABP支持时间明显短于IABP组[（53±5）h比（87±16）h],差异有统计学意义（P =0.047）;IABP＋参附组住院时间与IABP组比较[（14±9）d比（12±8）d],差异无统计学意义（P＞0.05）.2组患者院内及随访MACE事件发生率比较,差异均无统计学意义（P＞0.05）.Logistic回归分析发现,IL-6是STEMI并发CS患者发生院内MACE事件的独立危险因素（P=0.001）.结论 STEMI并发CS患者在接受IABP治疗的同时,给予参附注射液治疗可能通过降低IL-6浓度减轻心肌细胞和全身的炎性反应,从而减少CS患者对IABP的依赖,缩短CS患者疾病进程.

Objective To investigate the effect of Shenfu injection on inflammatory factors in patients with acute ST-segment elevation myocardial infarction （STEMI） complicated with cardiogenic shock （CS）.Methods Totally 60 patients with STEMI complicated with CS who underwent emergency percutaneous coronary intervention and intra-aortic balloon counterpulsation （IABP） from June 2013 to June 2015 were randomly divided into IABP group （30 cases） and IABP ＋ Shenfu group （30 cases）.IABP ＋ Shenfu group was given Shenfu injection 100 ml/24 h.The levels of C-reactive protein （CRP） and intedeukin-6 （IL-6） 24,48,72 h after admission were compared between groups.The IABP support duration,hospitalization stay time,incidence of major adverse cerebrovascular events （MACE） in hospital and follow-up period were compared between groups,and the independent risk factors of MACE in hospital were analyzed.Results The CRP level was significantly higher 24,48,72 h after admission than that immediately after admission in IABP ＋ Shenfu group and IABP group [IABP group：（33 ± 5）,（35 3）,（30 ±3） g/L vs （23 ±5） g/L,IABP ＋ Shenfu group：（31 ±4）,（31 ±5）,（28 ±5） g/L vs （26± 3） g/L],and in IABF ＋ Shenfu group,it was significantly lower than that in IABP group 48 and 72 h after admission （all P 〈0.05）.The IL-6 level in IABP ＋ Shenfu group was significantly higher than that in IABP group immediately after admission [（112 ± 19）ng/L vs （104 ± 10）ng/L] （P 〈0.05）,but the difference was not statistically significant 24,48 and 72 h after admission（all P 〉 0.05）.The IABP support duration in IABP ＋ Shenfu group was significantly shorter than that in IABP group [（53 ±5） h vs （87 ± 16） h] （P〈0.05）.The hospitalization stay time was not significantly different between IABP ＋ Shenfu group and IABP group [（14 ± 9） d vs （12 ± 8） d] （P 〉0.05）.The incidence of MACE in hospital and follow-up was not significantly different between groups.Logistic regression analysis showed that IL-6 was an independent risk factor of in-hospital MACE in patients with STEMI complicated with CS （P =0.001）.Conclusion In patients with STEMI complicated with CS who underwent IABP,simultaneous administrated with Shenfu injection can improve the systemic and cardiac muscle cells inflammatory reaction through reduction of IL-6 level,thus to reduce the dependence on IABP and shorten the course of CS.